Author + information
- Received November 26, 2012
- Revision received January 7, 2013
- Accepted January 14, 2013
- Published online April 1, 2013.
- Deepak K. Gupta, MD∗,
- Amil M. Shah, MD, MPH∗,
- Davide Castagno, MD†,
- Madoka Takeuchi, MS∗,
- Laura R. Loehr, MD, PhD‡,
- Ervin R. Fox, MD, MPH§,
- Kenneth R. Butler, PhD‖,
- Thomas H. Mosley, PhD‖,
- Dalane W. Kitzman, MD¶ and
- Scott D. Solomon, MD∗∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Scott D. Solomon, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, Massachusetts 02115.
Objectives In an entirely African-American cohort, we compared clinical characteristics, cardiac structure and function, and all-cause mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF) in relation to patients with heart failure with reduced ejection fraction (HFrEF) and those without HF.
Background African Americans are at increased risk for HF. Nevertheless, there are limited phenotypic and prognostic data in African Americans with HFpEF compared with those with HFrEF and those without HF.
Methods Middle-aged African Americans from the Jackson, Mississippi, cohort of the ARIC (Atherosclerosis Risk In Communities) study (n = 2,445) underwent echocardiography between 1993 and 1995. HF prevalence was available in 1,962 patients for whom left ventricular ejection fraction (LVEF) could be quantified. Participants with HF were categorized as having HFpEF (LVEF ≥50%), HFrEF (LVEF <50%), or no HF, with comparisons made between groups.
Results HF was identified in 116 (5.9%) participants (HFpEF n = 85 [73%]; HFrEF n = 31 [27%]). Compared with those without HF, those with HFpEF were older, were more likely to be female, and had more frequent comorbidities and concentric hypertrophy. In relation to HFrEF, those with HFpEF were more likely to be female but less likely to have coronary heart disease, diabetes mellitus, chronic kidney disease, left atrial enlargement, and eccentric hypertrophy. Over a median 13.7 years of follow-up, risk of death differed between groups, with age- and sex-adjusted hazard ratios of 1.51 (95% confidence interval: 1.01 to 2.25) for HFpEF versus those without HF and 2.50 (95% confidence interval: 1.37 to 4.58) for HFrEF versus HFpEF.
Conclusions In this cohort of middle-aged African Americans, HFpEF was the most common form of HF and was associated with a substantially better prognosis than HFrEF but worse than those without HF.
- heart failure with preserved ejection fraction
- heart failure with reduced ejection fraction
The ARIC study is supported by National Heart, Lung, and Blood Institute contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. Support was also provided by the National Heart, Lung, and Blood Institute training grant (T32 HL094301-02). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 26, 2012.
- Revision received January 7, 2013.
- Accepted January 14, 2013.
- American College of Cardiology Foundation